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    Multi-Axial Clinical Diagnosis

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    Develop a culturally relevent diagnosis including these guidelines:

    Axis I: Clinical disorders
    Axis II: Personality/ developmental disorders
    Axis III: Relevant physical disorders
    Axis IV: Psychosocial and Environmental problems
    Axis V: Global Assessment of Functioning
    Axis VI: Addressing

    Summarize the major issues in culturally competent assessment and explain how they can impact the process and progress of counseling/therapy.

    Case of Mrs. Hudson

    Mrs. Hudson is a 37-year-old Haitian American woman who lives with her husband of 10 years and two children, ages 8 (son) and 2 (daughter). She has come to therapy to discuss recent problems she has been having when leaving the house. She describes a pattern of behavior that began four months ago while shopping with her children. She was shopping for clothes for her daughter when she began to experience the following symptoms: heart racing, shortness of breath, sweating palm, and tightness in the chest. She worried that she might be having a heart attack and notified the store clerk who called the paramedics. The symptoms abated once the paramedics arrived and she was told to check with her primary care doctor. Mrs. Hudson described two subsequent incidents with similar symptoms--one at her son's school during a parent-teacher conference, and one at the office. She noted that she has begun spending much more of her time at home, has called in sick from work, and arranged for her husband to do the necessary shopping for the house. She has missed church for the past month and has not visited her family in the past two months. This has placed a strain on her marriage and she has exhausted her sick leave. If she doesn't return to work soon she will lose her job. She has not experienced any symptoms in the past month.

    In terms of history, Mrs. Hudson was born in Haiti in 1966 and lived with her paternal grandmother until the age of 7. Her mother and father emigrated to the United States shortly after Mrs. Hudson's birth, where they married and had three more children (one girl and two boys). Mrs. Hudson's mother sent for her when she was 7 and she lived with her mother, father, maternal grandmother, and siblings for the remainder of her childhood. Her mother had an elementary education and worked as a laborer in a sewing factory. Her father was a doctor in Haiti, but was unable to qualify to work as a doctor in the United States. According to Mrs. Hudson, he did not work during her childhood and her mother was the primary breadwinner. Mrs. Hudson described her relationship with her father as tense. She reported spending the majority or her life trying to gain his approval. Her father is now deceased (cancer). She reports being close to her mother and her siblings, particularly her sister. Mrs. Hudson's development was within average limits and she reached all developmental milestones at the appropriate age. She is bilingual (Creole/French derivative is her native language) and she learned English once she emigrated to the United States. While, Mrs. Hudson considers English to be her primary language she has never applied for citizenship. Mrs. Hudson completed college and medical school and worked part time as a primary care doctor in order to be home with her children. Mr. Hudson is a firefighter. Mrs. Hudson was raised Catholic and attended mass regularly as a child. She has since rejected Catholicism and now attends a nondenominational Christian church. She and her husband are physically healthy as is her older son. Her daughter was diagnosed with a severe heart condition at 14 months which required several surgeries to correct. Her daughter is still monitored regularly by her doctor. This is Mrs. Hudson's first visit to a mental health counselor. She was referred by her primary care doctor.

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    Solution Preview

    (1) Develop a culturally relevant diagnosis including these guidelines

    Mrs Hudson meets the criteria for excessive anxiety that characterizes patients with Panic disorder. She meets this criteria based on the three required clinical Diagnostic and Statistical Manual of Mental Disorders (DSM-IV, 2000) requirements for Panic Disorder with Agrophobia such as: (1) Anxiety about being in places or situations from which escape is difficult, (2) situations are avoided (e.g., restriction of travel) or endured with marked distress, and (3) Anxiety or phobic avoidance is not accounted for by another medical condition (DSM-IV-TR, 433).

    *Cultural issues associated with the diagnosis

    Based on DSM-IV features, there are several cultural variations to consider for Mrs hudson that include: (a) cultural identity, (b) cultural factors related to psychosocial environment and levels of functioning, (c) cultural elements of the relationship between the individual and the clinician, and (d) overall cultural assessment for diagnosis and care (p. 898). In addition, Mrs. Hudson's symptoms as noted in the vignette consist of no physical ailments, and she is physically healthy. Thus, based on the vignette there appears to be some psychosocial problems. As it is pointed out in DSM-IV guidelines, it is important to make this diagnosis within a cultural context. Mrs Hudson's behavior would suggest Panic Disorder with Agrophobia. Her multiaxial diagnosis is as follows:

    Axis I Panic Disorder with Agoraphobia
    Axis II V71.0 No diagnosis
    Axis III None
    Axis IV Daughter's ...

    Solution Summary

    This solution describes a culturally-rlevant assessment and diagnosis for a particular client.